It’s early morning, and intense pain jolts you awake. Not again. You’d hoped this nightmare was behind you—that the stabbing, burning sensation between your legs was gone for good. But it’s back, leaving you not only in severe discomfort but also with a crushing sense of hopelessness, a fear that relief may never come.
You can’t imagine ever having sex without pain. But it’s not just sex—living with constant pain in such a sensitive area makes everyday tasks unbearable. Sitting, wearing underwear, even the smallest movements become a struggle.
For someone living with vulvodynia, this story may sound all too familiar. A chronic condition affecting 8% to 10% of women in their lifetime, vulvodynia is often misunderstood and difficult to treat. Many endure years of discomfort before receiving a diagnosis.
Defined as persistent vulvar pain with no clear medical cause, vulvodynia can leave those affected feeling trapped on an unending merry-go-round, desperately searching for answers.
Psychologists from Sapienza University of Rome want to help. They propose that central sensitization—a process where the body becomes overly sensitive to pain—may contribute to this condition.
In their 2024 study in The Journal of Sexual Medicine, they explore how psychological and social factors influence this heightened sensitivity in women with vulvodynia and affect their quality of life. Through their research, they aim to open the door to better holistic care and end the prolonged suffering many women face.
Vulvodynia’s reach: beyond physical pain
When the central nervous system (the brain and spinal cord) becomes hyperresponsive, it amplifies pain perception. This phenomenon is referred to as central sensitization (CS). It’s as if the body cranks up the volume on pain signals—and the dial gets stuck on high.
In vulvodynia, several studies suggest CS may play a role, transforming minor stimuli from the vulvar region—like light touch, pressure, or wearing tight clothing—into intense discomfort.
But the impact of vulvodynia goes beyond physical pain. It affects both mental and sexual wellbeing.
In fact, research shows vulvodynia significantly reduces quality of life. Women with the condition report higher anxiety and depression, along with difficulties in daily activities and enjoying a satisfying sex life.
Investigating pathways to better vulvodynia care
Hoping to improve treatment options for vulvodynia patients, researchers surveyed 357 Italian women diagnosed with the condition by a specialist physician. Participants, all cisgender, ranged in age from 18 to 75, with an average age of 36.
The survey evaluated multiple factors, including physical and psychological quality of life, sensory processing sensitivity, traumatic experiences, personality traits, defense mechanisms, and mental pain. It also incorporated the Central Sensitization Inventory (CSI) to measure symptoms associated with an overly sensitive nervous system.
Researchers then examined how central sensitization, psychological and social influences, and quality of life are interconnected.
Vulvodynia, central sensitization, and quality of life
As central sensitization increased in women with vulvodynia, their physical and psychological quality of life declined.
The strongest predictors of high CSI scores were unhealthy coping mechanisms, heightened sensitivity to stimuli, mental pain, and past experiences of bodily threats. The study findings suggest these factors can worsen quality of life in vulvodynia by intensifying pain perception.
Notably, low sensory threshold and relying on neurotic defense mechanisms had the greatest impact on both central sensitization and overall quality of life.
What is low sensory threshold?
Individuals with low sensory threshold are more sensitive to environmental and social stimuli, requiring less stimulation to perceive or react to sensations. For example, they may feel overwhelmed by bright lights and loud noises, as if their senses are being bombarded.
The study found those with low sensory threshold were not only more likely to experience heightened pain sensitivity (central sensitization). They were also more likely to have higher levels of mental pain and experiences of past bodily threats. This supports previous research showing that difficult childhood experiences, including abuse, can increase the risk of developing vulvodynia in adulthood.
Unsurprisingly, the study found higher levels of mental pain negatively impacted the psychological quality of life of women with vulvodynia. In addition, those with more mental pain were more likely to have past experiences of bodily threats and use coping mechanisms like neurotic defenses.
What are neurotic defense mechanisms?
Neurotic defense mechanisms are unconscious strategies used to avoid or minimize distress, often by distorting or disconnecting from difficult emotions.
Examples linked to higher CSI scores include intellectualization, isolation of affect, and displacement. For instance, someone with vulvodynia might use intellectualization to cope with emotional pain. Rather than expressing distress over physical pain, they might focus on medical details or scientific explanations, creating emotional distance from their suffering.
However, such strategies may contribute to chronic pain by reinforcing pain avoidance behaviors, keeping the nervous system on high alert.
Tackling the physical and psychological
Taking a closer look at vulvodynia’s ties to pain sensitivity and psychological influences could empower patients to take charge of their health.
Several factors closely linked to central sensitization increased the risk of a poorer quality of life in women with vulvodynia. The most significant ones were low sensory threshold, neurotic defense mechanisms, mental pain, and past bodily threats. The findings also suggest psychological factors play a role in developing and sustaining central sensitization, fueling a cycle of chronic pain.
Addressing vulvodynia requires more than treating physical symptoms. A holistic approach—such as therapy to address past trauma or develop healthier coping strategies—may be crucial.
Clinicians who recognize high levels of central sensitization and understand its psychological contributors can offer more tailored treatments. This could help manage emotional distress and reduce vulvar pain, ultimately improving people’s overall quality of life.
